基于肺部超声的气道廓清方案在ICU机械通气患者中的应用

doi:10.3761/j.issn.0254-1769.2023.09.008

摘要/Abstract

摘要：

目的探讨基于肺部超声的气道廓清方案在ICU机械通气患者中的应用效果。方法采用目的抽样法，选取2021年1月—2022年6月入住合肥市某三级甲等综合医院ICU的机械通气患者，根据随机数字表法分为试验组和对照组。试验组实施基于肺部超声的气道廓清方案，对照组实施常规的气道廓清方案。比较干预第1、3、5天，两组肺部超声评分、氧合指数、膈肌功能情况及机械通气时间的差异。结果共纳入研究对象123例，其中17例因自动退出或在ICU入住未满5 d给予剔除，最终纳入106例，试验组56例，对照组50例。重复测量方差分析结果显示，两组肺部超声评分、氧合指数、膈肌运动幅度及膈肌厚度变异率的时间与组间存在交互效应（P<0.05）。两组机械通气时间比较，差异无统计学意义（P=0.902）。结论基于肺部超声的气道廓清方案有助于改善患者氧合状况，增强膈肌功能。

关键词: 超声检查, 气道管理, 呼吸, 人工, 重症监护病房, 护理

Abstract:

Objective To investigate the application effect of airway clearance program based on lung ultrasound in patients with mechanical ventilation in ICU. Methods A total of 106 mechanical ventilation patients admitted to the ICU of a tertiary A hospital in Hefei from January 2021 to June 2022 were selected by objective sampling method，and they were divided into an experimental group and a control group according to random number table method. The control group was given routine airway clearance program and the intervention group was given airway clearance program based on lung ultrasound. Pulmonary ultrasound scores，oxygenation index，diaphragm function and mechanical ventilation duration were compared between the 2 groups at the first，third and fifth days of intervention. Results A total of 123 cases were included in this study，among which 17 cases were excluded due to automatic withdrawal of less than 5 days in ICU. A total of 106 cases were finally included，including 56 cases in the experimental group and 50 cases in the control group. The results of repeated measurement analysis of variance showed that the pulmonary ultrasound score，oxygenation index， diaphragm thickness and thickness variation rate had statistical significance between groups， interaction and time effects（P<0.05）. There was no statistical significance in the mechanical ventilation time between the 2 groups（P=0.902）. Conclusion Airway clearance technique based on lung ultrasound can improve the oxygenation status and enhance the diaphragm function.

Key words: Ultrasonography, Airway Management, Respiration, Artificial, Intensive Care Units, Nursing Care

倪秀梅, 徐凤玲, 陈浩, 宫娟, 章翀, 王翠, 李宝芹, 胡少华. 基于肺部超声的气道廓清方案在ICU机械通气患者中的应用[J]. 中华护理杂志, 2023, 58(9): 1076-1081.

NI Xiumei, XU Fengling, CHEN Hao, GONG Juan, ZHANG Chong, WANG Cui, LI Baoqin, HU Shaohua. Application of airway clearance program based on lung ultrasound in patients with mechanical ventilation in ICU[J]. Chinese Journal of Nursing, 2023, 58(9): 1076-1081.

图/表 6

图1 肺部超声检查常见征象注：A为A线，红色箭头所指；B为B线，红色箭头所指；C为碎片征，红色圈内；D为组织样征，红色圈内；E为肺点，红色箭头所指；F为四边形征，红色长方形内；G为水母征，红色箭头所指。

Figure 1 Common signs of ultrasound examination of the lung

表1 基于肺部超声的ICU机械通气患者气道廓清方案

Table 1 The program of airway clearance technique based on lung ultrasound in patients with mechanical ventilation in ICU

表2 两组一般资料的比较（n=106）

Table 2 Baseline information of participants in 2 groups（n=106）

表3 两组干预前后肺部超声评分比较（分，$\bar{x}±s$）

Table 3 Comparison of pulmonary ultrasound scores before and after intervention between the 2 groups（score，$\bar{x}±s$）

表4 两组干预前后氧合指数比较（mmHg，$\bar{x}±s$）

Table 4 Comparison of oxygenation index before and after intervention between the 2 groups（mmHg，$\bar{x}±s$）

表5 两组干预前后膈肌运动幅度及厚度变异率比较（$\bar{x}±s$）

Table 5 Comparison of diaphragmatic motion amplitude and variation rate of diaphragm thickness before and after intervention between the 2 groups （$\bar{x}±s$）

参考文献 16

[1]	Lester MK, Flume PA. Airway-clearance therapy guidelines and implementation[J]. Respir Care, 2009, 54(6):733-750. DOI URL
[2]	关欣, 杨慧, 李栩亭, 等. 成人有创机械通气气道分泌物吸引的现状调查[J]. 中华护理杂志, 2020, 55(6):922-927. DOI
	Guan X, Yang H, Li XT, et al. Investigation on the current situation of airway secretion aspiration of invasive mechanical ventilation in adults[J]. Chin J Nurs, 2020, 55(6):922-927. DOI
[3]	Le Neindre A, Mongodi S, Philippart F, et al. Thoracic ultrasound:potential new tool for physiotherapists in respiratory management.A narrative review[J]. J Crit Care, 2016, 31(1):101-109. DOI URL
[4]	刘大为, 王小亭. 重症超声[M]. 北京: 人民卫生出版社, 2017.
	Liu DW, Wang XT. Severe ultrasound[M]. Beijing: People’s Medical Publishing House, 2017.
[5]	Bouhemad B, Liu ZH, Arbelot C, et al. Ultrasound assessment of antibiotic-induced pulmonary reaeration in ventilator-associated pneumonia[J]. Crit Care Med, 2010, 38(1):84-92. DOI PMID
[6]	李莲花, 杨倩, 李黎明, 等. 肺部超声评分评估急性呼吸窘迫综合征患者病情严重程度及预后的价值[J]. 中华危重病急救医学, 2015, 27(7):579-584.
	Li LH, Yang Q, Li LM, et al. The value of lung ultrasound score on evaluating clinical severity and prognosis in patients with acute respiratory distress syndrome[J]. Chin Crit Care Med, 2015, 27(7):579-584.
[7]	Andrews J, Sathe NA, Krishnaswami S, et al. Nonpharmacologic airway clearance techniques in hospitalized patients:a systematic review[J]. Respir Care, 2013, 58(12):2160-2186. DOI PMID
[8]	孙建华, 罗红波, 李尊柱, 等. 成人重症患者床旁超声引导鼻肠管置入的证据总结[J]. 中华护理杂志, 2023, 58(8):986-992. DOI
	Sun JH, Luo HB, Li ZZ, et al. Evidence summary for ultrasound-guided nasointestinal feeding tube placement in adult critically ill patients[J]. Chin J Nurs, 2023, 58(8):986-992. DOI
[9]	李菁, 王浩, 石永珍, 等. 超声引导下目标导向性胸部物理治疗在护理老年重症肺炎患者中的应用效果[J]. 现代中西医结合杂志, 2021, 30(12):1344-1347.
	Li J, Wang H, Shi YZ, et al. Application effect of ultrasound-guided target-oriented chest physical therapy in nursing elderly patients with severe pneumonia[J]. Mod J Integr Tradit Chin West Med, 2021, 30(12):1344-1347.
[10]	李欣, 王小亭, 李若祎, 等. 肺部超声主导的体位引流计划在重症肺炎患者中的应用[J]. 中华急危重症护理杂志, 2020, 1(5):448-451.
	Li X, Wang XT, Li RY, et al. Application of lung ultrasound-led posture drainage plan in patients with severe pneumonia[J]. Chin J Emerg Crit Care Nurs, 2020, 1(5):448-451.
[11]	曹岚, 孙杨, 张丽娜, 等. 基于肺部超声引导的护理策略在机械通气患者呼吸管理中的应用[J]. 中国护理管理, 2021, 21(3):331-337.
	Cao L, Sun Y, Zhang LN, et al. Application of nursing strategy guided by lung ultrasound in respiratory management of patients with mechanical ventilation[J]. Chin Nurs Manag, 2021, 21(3):331-337.
[12]	Boon AJ, O’Gorman C. Ultrasound in the assessment of respiration[J]. J Clin Neurophysiol, 2016, 33(2):112-119. DOI PMID
[13]	Goligher EC, Dres M, Fan E, et al. Mechanical ventilation-induced diaphragm atrophy strongly impacts clinical outcomes[J]. Am J Respir Crit Care Med, 2018, 197(2):204-213. DOI URL
[14]	杨卓, 迟红丽, 刘磊, 等. 胸部物理治疗对机械通气患者膈肌功能的影响[J]. 中华急危重症护理杂志, 2020, 1(4):336-340.
	Yang Z, Chi HL, Liu L, et al. Effects of chest physiotherapy on diaphragmatic function in patients with mechanical ventilation[J]. Chin J Emerg Crit Care Nurs, 2020, 1(4):336-340.
[15]	李蕊, 张萍, 魏鲁刚, 等. MHI对脑卒中患者膈肌运动和肺功能的临床疗效[J]. 昆明医科大学学报, 2021, 42(6):134-138.
	Li R, Zhang P, Wei LG, et al. Clinical effect of MHI on ki-aphragm movement and lung function in stroke patients[J]. J Kunming Med Univ, 2021, 42(6):134-138.
[16]	刘秀, 刘滨滨, 权明桃, 等. ICU机械通气患者膈肌锻炼方案的构建及应用研究[J]. 中华护理杂志, 2023, 58(3):261-267. DOI
	Liu X, Liu BB, Quan MT, et al. Construction and application of a diaphragm exercise program in patients with mechanical ventilation in ICU[J]. Chin J Nurs, 2023, 58(3):261-267. DOI